46D0938175 CLIA NUMBER - CENTRAL UTAH CLINIC PC MONROE CLINIC

Laboratory Demographics

CLIA Number: 46D0938175

Facility Name: CENTRAL UTAH CLINIC PC MONROE CLINIC

Facility Address:
260 E CENTER #206
PROVO, UT
ZIP 84604
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Facility Phone Number: 435 527-8866

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1437205028

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	46D0938175
LAB Type	Physician Office
Facility Name	CENTRAL UTAH CLINIC PC MONROE CLINIC
Street	260 E CENTER #206
City	PROVO
State	UT
ZIP	84604
Phone	435 527-8866
CertificateType	4
CertificateEffectiveDate	12/31/2023
CertificateExpirationDate	12/30/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024